Liposomal amphotericin B (AmBisome) in the treatment of neonatal candidiasis in very low birth weight infants

AmBisome (2.5-7 mg/kg/day as a continuous 1 h infusion) was evaluated prosp ectively from September 1994 to January 1998 in 24 very low birth weight in fants (mean birth weight 847 + 244 g, mean gestational age 26 weeks) with s ystemic candidiasis. Mean age at onset of candidemia was 17 days. One patie nt had two episodes of candidiasis. Thirteen infants failed previous antifu ngal therapy with amphotericin B (with or without 5-flucytosine). Candida s pp. were isolated from the blood in all 25 episodes and from skin abscesses and urine in four infants each, respectively. There were 13 isolates of Ca ndida albicans, ten of Candida parapsilosis, two of Candida tropicalis and one of Candida glabrata. One infant had a mixed infection with C. albicans and C. parapsilosis. The mean duration of therapy was 21 days; the cumulati ve AmBisome dose was 94 mg/kg. Fungal eradication was achieved in 92% of th e episodes; mean duration of AmBisome therapy until achieving eradication w as 9 days. Twenty (83%) infants were considered clinically cured at the end of treatment. No major adverse effects were recorded; one infant developed increased bilirubin and hepatic transaminases levels during therapy. Four (17%) infants died; in two of them (8%) the cause of death was directly att ributed to systemic candidiasis. Conclusion: AmBisome represents an effecti ve, safe and convenient antifungal agent in the therapy of systemic fungal infections in very low birth weight infants.